| NPI | 1154646131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: LA 308667) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A112314) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CA 112314) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2018-09-06 |